Message from the Chair and President: CAMH Annual Report 2003

CAMH Annual Report

When we set out five years ago to merge four diverse mental health and addiction institutions, the former Addiction Research Foundation, Clarke Institute of Psychiatry, Donwood Institute and Queen Street Mental Health Centre, we knew there would be great challenges.

But we had a vision: bringing together four organizations, each with its areas of expertise and unique culture, would increase access and improve standards of care for people with mental illness and substance use problems. The merger would also strengthen and broaden our provincial role and our capacity for research.

After five exciting years, the Centre for Addiction and Mental Health (CAMH) has an impressive list of achievements. While there is much more to do, we have made great strides in building an organization that is focused on the needs of our clients and stakeholders and on providing programs and services to improve the health of people and communities.

Our fifth anniversary is an important milestone. We have a lot to celebrate.

Building on our strengths

CAMH is Canada's largest health sciences centre devoted to mental illness and addiction. We have a clinical role caring for people with severe mental illness and addiction, with an inpatient capacity of more than 600 beds and extensive hospital and community-based outpatient services. As well, we have research, education and health promotion mandates.

Our research mandate extends from the basic science of molecular genetics and brain imaging through clinical therapeutics to social and policy research. Our education and training mandate extends from general public education and awareness to undergraduate and postgraduate training through to continuing medical and professional education. Our health promotion and prevention mandate includes clinical, research, policy and community-based initiatives.

Bringing together care, research, education and prevention in one organization has created a critical mass of talent and expertise. Every day, we are advancing our ability to help clients, families, community agencies and the general public.

In addition, integrating mental health and addiction services has helped us understand concurrent disorders and develop innovative approaches to care. CAMH was pleased to take a lead role in developing and disseminating Health Canada's Best Practices -- Mental Health and Substance Use Disorders.

Increasing capacity and improving quality of care

Everything we do at CAMH is geared to promoting health and improving the lives of those affected by addictions and mental health problems. The results of our first five years are impressive.

We are serving more clients. Care has increased by 25 per cent. Our admissions are up 35 per cent. As well, we are training 30 per cent more health professionals. We have increased research funding by 57 per cent. We are also more efficient. We have redirected $20 million from our operating costs to direct client care in clinical programs and to achieve our strategic directions.

Serving the needs of clients

Not only is CAMH concerned with serving more clients, but we are also concerned with serving them better. Whether in care, research, education or health promotion, our work is focused on how we can best meet the needs of clients.

Client-centred care means looking at the diverse needs of our clients. This year, we have extended our use of a new assessment tool, the Interdisciplinary Plan for Client Care. This tool ensures that each client has a care plan that addresses his or her medical/therapeutic goals and goals related to issues such as housing, employment, and income and social supports.

These issues have a critical impact on clients' recovery. That's why CAMH is making them a priority. Among other initiatives, we launched a new Sunshine Garden at the Queen Street site that employed 14 clients for six months. As well, we divested the Out of This World Café and Espresso Bar -- which started as a hospital rehabilitation program -- to the Ontario Council of Alternative Businesses as an independent business employing 35 clients. We are also committed to addressing the needs of diverse client groups.

This year, our Board of Trustees approved a comprehensive Diversity Policy Framework. This framework sets out a plan to ensure CAMH becomes more accessible to the many people in the community who experience barriers to mental health and addiction care. We have started a province-wide needs assessment to help shape our provincial priority on diversity. Initiatives in 40 programs, the launch of our Centred on Diversity awareness campaign and diversity training for more than 1,000 staff have put organizational change and diversity high on our agenda.

Another priority focus is promoting more client and family input. This year, we signed formal agreements with the Empowerment and Family Councils to give them more autonomy and a larger, better-defined role. We are changing the way we work, based on the recognition that clients have a right to participate in issues that affect them. This year, clients took part in functional planning committees, influenced the design of new inpatient units, and helped set directions for programs and policies. Our new Policy of Least Restraint is an example of the influence of client involvement. The policy, which includes education in its implementation, reflects a client perspective, supports clients and caregivers and emphasizes respect for clients.

CAMH is committed to ongoing work with clients to find ways we can improve the care we offer. We have now instituted client surveys in every clinical program. Client satisfaction surveys allow us to understand client needs better. This has led to a series of changes that affect the daily lives of inpatients, including more liberal visiting hours, more choice at meals and increased recreation.

Becoming more connected

Just as client input is a priority, so is input from community partners and other stakeholders. From day one, we have tried to create community connections and play a more defined role in the larger health care system.

When CAMH was established in 1998, we instituted a governance model with 70 constituency members from across the province. These members vote at our Annual General Meeting, elect the Board of Trustees, and provide input on key initiatives. This governance model was an innovative way to reflect the broad scope of our mandate and guarantee diverse stakeholders a voice in decision-making. Today, it complements our commitment to build new partnerships, coalitions and joint ventures.

Partnerships are fundamental to offering a continuum of care and meeting clients' needs. Our new partnership with St. Christopher House in downtown Toronto offers services for substance use problems to Aboriginal men, an underserved community. Our partnership with Peel providers delivers inpatient schizophrenia treatment to clients in that area. This partnership expands our capacity and brings care closer to clients. We also work in partnerships throughout the province in our education, health promotion and system planning roles. For example, we share leadership of the Northeast Mental Health Public Education Campaign, We All Belong, with the Canadian Mental Health Association Ontario Division and the Northeast Mental Health Centre.

Changes in programs and services

We have made a number of changes to our programs and services this year based on new best practices. The merger of our neuropsychiatry and geriatrics programs allows CAMH to better serve clients who are older adults; our new Integrated Rehabilitation Unit (IRU) provides intensive rehabilitation to clients of long-term schizophrenia services; our new 13-bed inpatient unit meets the specialized needs of people who have mood and anxiety problems.

Program planning has been a major focus throughout the entire year. Over the past 18 months, we worked with clients, families, neighbours, community agencies and other health care providers to complete our Functional Program for the Queen Street site redevelopment. We believe that this important blueprint for future programs and services will make CAMH a model for mental health and addiction care worldwide.

Putting all the pieces in place

With our focus on improving the lives of those affected by mental illness and addictions and creating communities in which people with mental health and addiction problems can live as full participants in society, we know that providing good clinical care is not enough.

CAMH's work in the areas of research, health promotion and education ensures that new understanding and knowledge are translated into new approaches to client care and preventing and treating mental illness and addiction.

Partially because of stigma, research on mental illness and substance use has been seriously under-funded compared with other areas of medicine. We cannot overstate the importance of the steady increase in research funding we have secured since CAMH was created. Nor can we overstate the impact of new research breakthroughs on the quality of the lives of people affected by mental health and substance use problems. It is truly exciting.

Our internationally recognized researchers are making a difference by helping people affected by mental illness and addictions and creating healthy communities. They are leading the way in their diverse fields of study, ranging from best practices in concurrent disorders to student alcohol and drug use surveys; from the links between genetics and schizophrenia to the effects of poverty on the mental health of immigrant children; from the impacts of drug therapy on psychotherapy to the impact of unfair workplace treatment on the mental health of employees.

CAMH has a unique capacity not only to focus our research on pressing needs but also to translate new knowledge into action. Through our varied education and publishing initiatives, our province-wide mandate and our satellite offices across Ontario, we work with community partners to disseminate and exchange information widely about new research and best practices.

This year we launched a new integrated plan for our provincial role, focusing on three priorities (youth, concurrent disorders and diversity) and emphasizing our combination of research, development and dissemination activities.

An early success was our province-wide videoconference to share best practices for concurrent disorders with more than 260 agencies. After our researchers and clinicians produced a successful best practices guide, our regional system planning consultants, building on the work of their colleagues, are now using the recommendations from the guide to work directly with agencies and planning bodies to address concurrent disorders in client care.

Regional staff have also been working with public health and other local stakeholders on municipal smoking bylaws. We lobbied for Criminal Code amendments to lower legal blood alcohol content, and promoted our harm reduction approach to substance use.

Building for the future

Just as current initiatives are built on our knowledge of best practices and the needs of clients, so are our plans for the future. Evidence shows that people respond best to treatment in spaces that feel normal and familiar. This is the foundation for our Queen Street site redevelopment plans.

We propose to redevelop our 27-acre site as an urban village designed to "de-institutionalize" the institution. With public streets running through the site, flexible buildings, each with its own

front door, public and private green spaces, and non-CAMH uses, we will integrate our facilities into a community setting of care. This integration not only reflects best practices, but it also reflects our commitment to tackle stigma, a significant barrier for people with mental health problems and substance use problems.

Most of our plans for the future are closely tied to redeveloping our Queen Street site as our central hub, with links throughout the province. As long as we operate on four sites in Toronto, and our operations are housed in outdated and inflexible hospital buildings, we cannot realize the full advantages of the merger or make the changes to programs and care to better meet clients' needs. We have submitted our plans for our site master plan and our functional program to the City of Toronto and the Ontario Government's Ministry of Health and Long-Term Care for approvals and funding. We hope to begin construction in 2004.

Continuous improvement

Because we are committed to improving the quality of our work, we set out this year to renew our strategic plan. Our first strategic plan, approved in 1999, guided us through our first five years. Our new plan, which will direct our next three years, sets out our commitments -- to client-centred practice, diversity, a holistic view of health, partnerships, continuous learning and accountability -- and the steps we will take to make a difference for the people and communities we serve. It builds on what we have learned in our first five years, and includes advice from clients, families and other stakeholders.

Our success is based on people

Many people have contributed to CAMH's development. First are our clients, who are at the very centre of our organization.

CAMH is what it is today due in large part to our committed and talented staff. In appreciation of their hard work, over the past year we initiated ways to formally recognize staff. In October, we hosted our first-ever Ted Tremain Staff Recognition Awards dinner, where 17 staff were publicly acknowledged for providing high-calibre service, leadership, commitment and enthusiasm in their work. These awards will continue as an annual event. As part of our anniversary celebrations, we held a birthday party. At this party, all staff received a memento, and we presented service awards to staff who have worked with CAMH and one of our founding partners for 10 or more years. In addition, we host an annual tea for all staff who have retired.

Beyond our staff, our volunteers, including our Board of Trustees, have played a critical role in our organization. Over the past year, volunteers have provided over 270,000 hours in service to CAMH.

Our close working relationships with our community partners, other health care providers, neighbours and other stakeholders are also important to the way we work within the mental health and addiction systems.

While our work is a collective effort, one person deserves special thanks. After leading our organization for five years, Jean Simpson, our Executive Vice President and Chief Operating Officer, has announced her retirement. Many of the achievements that we are celebrating reflect Jean's leadership. Her passionate commitment to client-centred care, client empowerment, improved standards, diversity, partnerships and anti-stigma education has helped shape CAMH as an organization committed to our clients, our stakeholders and the communities we serve.

Although it's important to reflect on our impressive achievements as an organization, it's just as important to look to the future. We have many opportunities ahead of us, and we are confident that our plans for the future will be a good road map for our journey ahead.

Pamela C. Fralick, Chair
Dr. Paul Garfinkel, President and CEO